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What is the permanent cure for de Quervain's tenosynovitis? What are the findings from the steroid profile test?

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Orthopaedic Surgeon
Practicing since : 1998
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Hello, I'm a IT consultant and I had quit smoking in Feb 2013. After few months I had the following symptoms: Severe Joint pain (especially knees/shoulders) Hive like itchy rashes Extreme fatigue and weakness de Quervain's tenosynovitis [1] [1] Based on the symptoms and test (Finkelstein's test) mentioned here WWW.WWWW.WW I consulted a GP in March and he gave me some pain killers (pills & ointment) and asked to wear a wrist brace for the tenosynovitis. He also asked for a CRP test and the CRP level was found elevated. After the symptoms got worse and started affecting my work, I consulted an immunologist and got my blood test done on 15th Nov 2013 (reports attached). The doctor concluded the following: Vitamin-D deficiency Spontaneous Urticaria Slightly elevated Cholesterol level I was recommend Uprise D3 60k once weekly for 12 weeks for joint pain and Combination of Fexofenadine & Levocetirizine for rashes. After 2 weeks of above medication, I observed the following: Knee/shoulder joint pain got a bit better No/Little rashes (Hives) when on Fexofenadine or Levocetirizine. No/Little Fatigue & Weakness However, one thing that did not improve at all is the de Quervain's tenosynovitis. Initially I had the pain in my right wrist but now I got the pain (and wear braces) on both wrists. The pain is very severe and prevents me from working on computer, lifting weights, holding things etc.. My job demands me to be on laptop for 12-14 hours a day and this condition is affecting my performance & productivity. Also, I recently got a pain in my elbow which won't go away even after taking pain killers (Ultracet, brufen, hifenac). I've observed that as if my bone,tendons have become more fragile and the injuries are taking a while to recover (or not recovering). I'm exercising daily (1 hour aerobics/yoga) but these conditions get worse during/after exercise. I'm aware that for tendinitis the following are suggested: Painkillers Wrist Braces Corticosteroid injections (Oral ?) Surgery But I believe, that's like suppressing the symptoms than fixing the root cause. I got a steroid profile test done on 27 Nov 2013 (Reports attached) to check the cortisol/dhea levels. I want your help figuring out the root cause and how we can fix it. I've attached all the reports for your reference. Few questions for you: Looking at the report,could it be related to Osteoporosis as Vitamin-D deficiency is involved ? Does DHEA & Cortisol levels look ok ?. Does that say anything about the condition ? Would a BMD (DEXA) scan results help ? In the report dated 27 Nov 2013, the Vitamin - D (D3+D2) levels look like back to normal. Is it possible within two weeks of 60k IU Vit-D supplementation ? What can I do for the for the tenosynovitis? It's really affecting my work. Thanks, XXXX
Posted Fri, 20 Dec 2013 in Bones, Muscles and Joints
Answered by Dr. Vaibhav Gandhi 1 hour later
Brief Answer: Hello Detailed Answer: Hello I have studied your case Thumb spica splint will be suitable for de Quervain's tenosynovitis. Physiotherapy like USG and TENS will help in relieving symptoms. Avoid twisting activity of wrist. Till time continue your medication. If not relieved local steroid injection will help Last aspect remains surgical release as long term cure. If at young age you are having low vitamin D then there is high possibility that you will have osteoporosis .there is not time recorded as after that there will be osteoporosis. Yes with two doses it may come near normal. You can do DEXA scan to check your bone density Your Cortisol and deoxycortisol levels are elevated which indicate stress in your life, you need to start various relaxing technique [eg meditation] Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
Follow-up: What is the permanent cure for de Quervain's tenosynovitis? What are the findings from the steroid profile test? 18 hours later
Thank you.
Answered by Dr. Vaibhav Gandhi 6 hours later
Brief Answer: Welcome Detailed Answer: Take care
Above answer was peer-reviewed by
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